Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

Abstract

Background. Therapeutic EUS (t-EUS) is increasingly adopted in clinical practice of tertiary referral centres; however, little is known about Radiation Exposure (RE) metrics and Diagnostic Reference Limits. Methods. Kerma-Area Product (KAP [Gy·cm2]), Air Kerma and Fluoroscopy Time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019-2021. For EUS-guided Choledochoduoenostomies (EUS-CDS) and Gastroenterostomies (EUS-GE) an equal number of ERCPs + metal stenting and Duodenal Stentings were included for comparison. Results. 141 t-EUS procedures were retrieved (49% pancreatic cancer, 38% peripancreatic fluid collections). EUS-CDS (N=44) were mainly performed fluoroless, while ERCPs required a significantly higher RE (KAP=25 [17-55], p<0.0001). Fluid collection drainage (EUS-FCD) with Lumen Apposing stents (LAMS, N=26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N=28) required higher RE (KAP=23 [13-45]). EUS-guided gallbladder drainage (EUS-GBD, N=6) required scarce RE (KAP=9 [3-21]) for coaxial DPPS placement. EUS-GE (N=27) required higher RE than Duodenal Stenting (KAP=44 [28-88] versus 29 [19-46], p=0.03). EUS-guided Hepatico-Gastrostomies (EUS-HGS, N=10) had the highest RE amongst t-EUS procedures (KAP=81 [49-123]). Procedure complexity or intervening complications were evaluated and resulted in higher RE within each procedure. Conclusions. t-EUS procedures have different RE (p<0.000001). EUS-Choledochoduodenostomy, Gallbladder Drainage and Fluid Collection Drainage with LAMS can be performed with no-to-mild radioscopy, unlike standard alternatives. However, radioscopy remains essential in case of technical difficulties or complications. EUS-Gastroenterostomy and EUS-Hepaticogastrostomy involve a high RE. Endoscopists involved in t-EUS might experience a RE superior to category standards, claiming for increased awareness and personalized preventive measures.

Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope

“…Shortening the procedure time and fluoroscopy time reduces the burden on both the operator and the patient, but it is particularly important to shorten the fluoroscopy time [26][27][28]. The early and late effects of radiation exposure in normal tissues and organs are an issue for pancreatobiliary treatment, in which fluoroscopy is required [29].…”

Endoscopic ultrasound‐guided transmural pancreatic cyst drainage using an electrocautery lumen‐apposing metal stent without fluoroscopy for critically ill patients in the intensive care unit setting

“…Endoscopic ultrasound (EUS)‐guided cyst drainage (EUS‐CD) with an electrocautery lumen‐apposing metal stent (EC‐LAMS) is widely used 1,2 . The deployment of EC‐LAMS is mainly performed with fluoroscopy; however, there are several situations (due to patient and machinery conditions) in which fluoroscopy cannot be used 3 . This study reports a case of an infectious pancreatic pseudocyst (PPC) treated by EUS‐CD using EC‐LAMS without fluoroscopy.…”

“…1,2 The deployment of EC-LAMS is mainly performed with fluoroscopy; however, there are several situations (due to patient and machinery conditions) in which fluoroscopy cannot be used. 3 This study reports a case of an infectious pancreatic pseudocyst (PPC) treated by EUS-CD using EC-LAMS without fluoroscopy. A 46-year-old man with a history of chronic alcoholic pancreatitis presented to our institution with high fever and shock.…”